[Peripartum cardiomyopathy with biventricular failure plus pulmonary thromboembolism and atrial septal defect]. / Miocardiopatía periparto con fallo biventricular más tromboembolismo pulmonar y comunicación interauricular.

This case report examines peripartum cardiomyopathy (PPCM), a rare variant of heart failure with reduced ejection fraction, which manifests at the end of labor or puerperium. The frequency of this pathology varies globally, and its association with risk factors such as genetic disorders, autoimmune diseases, viral infections, suggests a multifactorial etiology. Diagnostic criteria include: Heart failure secondary to left ventricular systolic dysfunction, manifested in the puerperium or at the end of pregnancy and lack of other identifiable causes of heart failure. The case presents a patient with no significant personal pathological history, who, 17 days post cesarean section developed acute symptoms, including abdominal pain, dry cough and dyspnea. Clinical findings revealed hypoxemia, alterations in blood tests and an echocardiogram that confirmed an atrial septal defect. Multidisciplinary management resulted in successful treatment and the patient was discharged without complications. This case highlights the importance of MCPP, a disease with high maternal mortality. The connection between atrial septal defect and PPCM, as well as the involvement of pulmonary thromboembolism.

A 2D ferroelectric vortex pattern in twisted BaTiO3 freestanding layers.

The wealth of complex polar topologies1-10 recently found in nanoscale ferroelectrics results from a delicate balance between the intrinsic tendency of the materials to develop a homogeneous polarization and the electric and mechanical boundary conditions imposed on them. Ferroelectric-dielectric interfaces are model systems in which polarization curling originates from open circuit-like electric boundary conditions, to avoid the build-up of polarization charges through the formation of flux-closure11-14 domains that evolve into vortex-like structures at the nanoscale15-17 level. Although ferroelectricity is known to couple strongly with strain (both homogeneous18 and inhomogeneous19,20), the effect of mechanical constraints21 on thin-film nanoscale ferroelectrics has been comparatively less explored because of the relative paucity of strain patterns that can be implemented experimentally. Here we show that the stacking of freestanding ferroelectric perovskite layers with controlled twist angles provides an opportunity to tailor these topological nanostructures in a way determined by the lateral strain modulation associated with the twisting. Furthermore, we find that a peculiar pattern of polarization vortices and antivortices emerges from the flexoelectric coupling of polarization to strain gradients. This finding provides opportunities to create two-dimensional high-density vortex crystals that would enable us to explore previously unknown physical effects and functionalities.

[Atlantoid assimilation: malformation, compensation or deformity. Is it part of basilar invagination?] / Asimilación atlantoidea: malformación, compensación o deformidad. ¿Es parte de la invaginación basilar?

INTRODUCTION: atlas assimilation can occur alone or in association with other craniocervical junction malformations and deformities. The etiological and pathological mechanisms are not clear. CASE PRESENTATION: patient in her sixth decade of life, who was treated at the "Eugenio Espejo" Hospital, with asymmetric pyramidal symptoms after a low-energy kinetic fall. The condition completely reverted with conservative management. The patient is currently under periodic observation. CONCLUSION: the atlas assimilation, a congenital malformation, often asymptomatic; it is part of an embryological compensation when it is associated with other malformations. The appearance of deformity is necessary to reach atlantoaxial instability that it is not early. The knowledge of the concepts and distinction of the craniocervical junction abnormalities allows to indicate the best treatment in order to obtain the most suitable results with the individualization of each case.

INTRODUCCIÓN: la asimilación atlantoidea puede presentarse sola o asociada a otras malformaciones y deformidades de la unión craneocervical, los mecanismos etiológicos y patológicos no están esclarecidos. PRESENTACIÓN DE CASO: paciente de la sexta década de vida, quien fue atendida en el Hospital de Especialidades "Eugenio Espejo", con datos clínicos piramidales asimétricos, posteriores a mecanismo de lesión de caída con cinética de baja energía. La sintomatología revirtió con manejo conservador. En la actualidad, la paciente está bajo observación periódica. CONCLUSIÓN: la asimilación atlantoidea es una malformación congénita muchas veces asintomática y parte de una compensación embriológica cuando está asociada a otras malformaciones. Es necesaria la aparición de deformidad para llegar a la inestabilidad atlantoaxoidea que no es temprana. El conocimiento y poder diferenciar los conceptos de las anormalidades de la unión craneocervical permiten indicar el mejor tratamiento y así obtener los resultados más adecuados con la individualización de cada caso.

Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature / Quistes aracnoideos intracraneales y epilepsia en niños: ¿Debemos tratarlos quirúrgicamente? Nuestra experiencia de 29 años y revisión de la literatura

Introduction and objective: Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. Material and methods: The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. Results: After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment(AU)

Introducción y objetivo: Los quistes aracnoideos (QAs) son lesiones relativamente comunes relacionados con diferentes síntomas neurológicos, siendo diagnosticados de forma incidental en su mayoría. Este estudio tiene como objetivo aclarar si la cirugía sobre el QA en pacientes epilépticos es útil en su tratamiento. Material y métodos: Se analizan retrospectivamente los pacientes registrados en la base de datos de la Sección de Neuropediatría desde mayo de 1990 a agosto de 2019. Se estudian los pacientes en los que coincide el diagnóstico de QA y epilepsia. Se analiza la localización, tamaño y número de los QA, el desarrollo neurológico, edad al diagnóstico, tiempo de seguimiento, realización de cirugía sobre el QA, evolución, relación anatómica entre la actividad eléctrica cerebral y la localización del QA, así como el tipo de epilepsia. Resultados: Tras el análisis de la base de datos encontramos 1.881 pacientes diagnosticados de epilepsia, entre ellos 25 con al menos un QA intracraneal. En nueve de los pacientes la patología cerebral o genética por sí misma era causa de epilepsia. De los otros 16, únicamente en dos casos se evidenció que el tipo de epilepsia y el foco epileptogénico coincidían con la localización del QA; uno de ellos fue tratado quirúrgicamente sin éxito y el otro permaneció asintomático sin recibir tratamiento médico ni quirúrgico. Conclusiones: Aunque es necesario diseñar un estudio prospectivo para establecer causalidad, los resultados de nuestro trabajo y la literatura disponible sugieren que no hay relación causal entre la presencia de QAs y epilepsia. El estudio y tratamiento de estos pacientes debería ser completado en una unidad multidisciplinar de cirugía de la epilepsia, sin asumir de inicio que el QA es la causa de la epilepsia(AU)

Complicaciones intracraneales graves secundarias a infecciones por Streptococcus intermedius / Serious intracranial complications secondary to Streptococcus intermedius infections

Streptococcus intermedius es un microorganismo anaerobio, perteneciente al grupo de Streptococcus anginosus. Es una bacteria comensal habitual de la cavidad oral y nasofaringe, conocida por su potencial capacidad de formar abscesos cerebrales por contigüidad o por vía hematógena a partir de infecciones de la esfera otorrinolaringológica. Las infecciones del sistema nervioso central debidas a miembros de este grupo son potencialmente mortales y requieren de un manejo multidisciplinar. La obtención de imágenes mediante tomografía computarizada o resonancia magnética debe realizarse de forma precoz para evaluar las colecciones que requieren drenaje. La intervención quirúrgica y el inicio de terapia antibiótica empírica a tiempo son imprescindibles para asegurar una correcta evolución (AU)

treptococcus intermedius is an anaerobic bacterium and a member of the Streptococcus anginosus group. It is a commensal bacterium of the oral cavity and nasopharynx, which is known for its potential ability to form brain abscesses by contiguity or hematogenous dissemination from infections of the otorhinolaryngological sphere. Central nervous system infections due to members of this group are life-threatening and need multidisciplinary management. Imaging with computed tomography or magnetic resonance imaging should be performed as soon as possible to evaluate the collections requiring drainage. Timely initiation of surgical intervention and appropriate empirical antibiotic therapy are essential to ensure a correct evolution. (AU)

Traumatismo craneal por maltrato. Revisión de nuestra experiencia / Abusive head trauma. A review of our experience

Introducción: El traumatismo craneal por maltrato (TCM) se define como todo traumatismo que ocasiona lesiones intracraneales debido a un impacto directo infligido y/o zarandeo, y se caracteriza por la tríada de encefalopatía, hemorragias retinianas y hematoma subdural. El objetivo de este estudio es conocer las características epidemiológicas, clínicas y radiológicas, así como las secuelas de los pacientes diagnosticados de TCM. Pacientes y métodos: Estudio descriptivo observacional retrospectivo de los 19 pacientes diagnosticados de TCM en un hospital terciario entre 1990 y 2018, ambos inclusive. Resultados: La edad media de los afectados fue de 5,5 meses y existe paridad entre ambos sexos. Las anamnesis aportadas por los cuidadores fueron: ausencia de traumatismo (n = 9), antecedente de caída (n = 6) y zarandeo (n = 4). La clínica inicial más prevalente fueron los síntomas graves, y las convulsiones fueron el síntoma más frecuente (n = 8). Quince pacientes presentaron hemorragias retinianas y otros 15, hematoma subdural o higroma. Dos pacientes fallecieron, siete presentaron secuelas en el alta y 10 de los 12 pacientes en los que se realizó seguimiento presentaron secuelas tardías manifestadas como secuelas cognitivas/comportamiento (n = 5) o como secuelas neurológicas (n = 6). Conclusiones: Las características epidemiológicas, clínicas y radiológicas son muy similares a las publicadas en la bibliografía. La presencia de secuelas es prevalente y éstas se manifiestan tanto como problemas cognitivos y de comportamiento como por secuelas neurológicas.(AU)

Introduction: Abusive head trauma (AHT) is defined as an injury to the skull or intracranial contents due to inflicted blunt impact and/or shaking. It is characterized by the triad: encephalopathy, retinal haemorrhages and subdural hematoma. The main objective is to know the epidemiological, clinical and radiological characteristics; as well as the short and long term outcomes of patients diagnosed with AHT. Patients and methods: It is a descriptive, observational and retrospective study of the 19 patients diagnosed with AHT at a tertiary hospital from 1990 to 2018, both included. Results: The mean age of the patients was 5,5 months with parity between both sexes. The principal medical histories reported were: absence of trauma (n = 9), history of a short fall (n = 6) and shaking (n = 4). The most frequent initial presentation was severe, and seizures was the main symptom (n = 8). Retinal haemorrhages were present in fifteen patients and subdural hematoma or hygroma in fifteen patients. Two patients died, seven presented short-term outcomes, and ten of the twelve patients who were performed a follow-up presented long-term outcomes. These outcomes were manifested as cognitive or behavioural disorders (n = 5) or as neurological disorders (n = 6). Conclusions: The epidemiological, clinical and radiological characteristics found are very similar to those reported in the literature. The prevalence of outcomes is high and they appear as cognitive or behavioural disorders.(AU)

[Abusive head trauma. A review of our experience]. / Traumatismo craneal por maltrato. Revisión de nuestra experiencia.

INTRODUCTION: Abusive head trauma (AHT) is defined as an injury to the skull or intracranial contents due to inflicted blunt impact and/or shaking. It is characterized by the triad: encephalopathy, retinal haemorrhages and subdural hematoma. The main objective is to know the epidemiological, clinical and radiological characteristics; as well as the short and long term outcomes of patients diagnosed with AHT. PATIENTS AND METHODS: It is a descriptive, observational and retrospective study of the 19 patients diagnosed with AHT at a tertiary hospital from 1990 to 2018, both included. RESULTS: The mean age of the patients was 5,5 months with parity between both sexes. The principal medical histories reported were: absence of trauma (n = 9), history of a short fall (n = 6) and shaking (n = 4). The most frequent initial presentation was severe, and seizures was the main symptom (n = 8). Retinal haemorrhages were present in fifteen patients and subdural hematoma or hygroma in fifteen patients. Two patients died, seven presented short-term outcomes, and ten of the twelve patients who were performed a follow-up presented long-term outcomes. These outcomes were manifested as cognitive or behavioural disorders (n = 5) or as neurological disorders (n = 6). CONCLUSIONS: The epidemiological, clinical and radiological characteristics found are very similar to those reported in the literature. The prevalence of outcomes is high and they appear as cognitive or behavioural disorders.

TITLE: Traumatismo craneal por maltrato. Revisión de nuestra experiencia.Introducción. El traumatismo craneal por maltrato (TCM) se define como todo traumatismo que ocasiona lesiones intracraneales debido a un impacto directo infligido y/o zarandeo, y se caracteriza por la tríada de encefalopatía, hemorragias retinianas y hematoma subdural. El objetivo de este estudio es conocer las características epidemiológicas, clínicas y radiológicas, así como las secuelas de los pacientes diagnosticados de TCM. Pacientes y métodos. Estudio descriptivo observacional retrospectivo de los 19 pacientes diagnosticados de TCM en un hospital terciario entre 1990 y 2018, ambos inclusive. Resultados. La edad media de los afectados fue de 5,5 meses y existe paridad entre ambos sexos. Las anamnesis aportadas por los cuidadores fueron: ausencia de traumatismo (n = 9), antecedente de caída (n = 6) y zarandeo (n = 4). La clínica inicial más prevalente fueron los síntomas graves, y las convulsiones fueron el síntoma más frecuente (n = 8). Quince pacientes presentaron hemorragias retinianas y otros 15, hematoma subdural o higroma. Dos pacientes fallecieron, siete presentaron secuelas en el alta y 10 de los 12 pacientes en los que se realizó seguimiento presentaron secuelas tardías manifestadas como secuelas cognitivas/comportamiento (n = 5) o como secuelas neurológicas (n = 6). Conclusiones. Las características epidemiológicas, clínicas y radiológicas son muy similares a las publicadas en la bibliografía. La presencia de secuelas es prevalente y éstas se manifiestan tanto como problemas cognitivos y de comportamiento como por secuelas neurológicas.

Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación / Optic neuritis in paediatric patients: Experience over 27 years and a management protocol

Introducción y objetivos: Se presenta nuestra experiencia en neuritis óptica (ON) y se elabora un protocolo diagnóstico-terapéutico, que contempla descartar otras causas, principalmente infecciosas y se elabora una hoja informativa para padres.Material y métodoEstudio descriptivo retrospectivo de los pacientes con ON en 27 años (1990-2017). Revisión de evidencia científica para elaboración del protocolo y hoja informativa.ResultadosEn nuestra sección de neuropediatría se valoraron 20.744 niños en 27 años, 14 con ON: 8 ON aisladas, una esclerosis múltiple (EM), un episodio clínicamente aislado (CIS), 3 encefalomielitis agudas diseminadas y un paciente con ON aislada que el año anterior había sufrido una encefalomielitis aguda diseminada. Edades entre 4-13 años, 50% varones. Mayores de 10 años, 8 pacientes: 7 ON aisladas y un EM. Bilaterales 9, retrobulbares 3. Resonancia magnética cerebral normal en 7, solo afectación del nervio óptico en 2 y con desmielinización del SNC en 5 casos. Recibieron corticoterapia 13/14. Un caso vacunado de meningococo-C el mes anterior. Todos evolucionaron favorablemente, salvo la EM. Se presentan el protocolo y la hoja de información.ConclusionesHabitual curso favorable. En niños a partir de 10 años, con factores de riesgo de desarrollar EM o neuromielitis óptica (presencia de hiperseñales en RM cerebral, bandas oligoclonales, anti-NMO, recurrencia de ON), se consensúa con Neurología el inicio de tratamiento inmunomodulador. Utilidad del protocolo para la toma de decisiones diagnósticas, de seguimiento y tratamiento, de una patología poco frecuente pero con posibles repercusiones importantes. Importancia de la protocolización y hojas informativas. (AU)

Introduction and objective: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents.Material and methodsWe conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet.ResultsOur neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients’ age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided.ConclusionsON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important. (AU)

Point-of-care ultrasound after attempted suicidal hanging.

Focused cardiac ultrasound (FoCUS) can provide critical information quickly to determine the etiology after cardiac arrest and may expedite a diagnosis in order to identify underlying treatable causes. We present a case of reversible acute left ventricular dysfunction after cardiopulmonary resuscitation following attempted suicide by hanging presenting with severe hypoxemia. FoCUS revealed findings consistent with severe left ventricular dysfunction, and point-of-care ultrasound (PoCUS) ruled out pneumothorax. These findings, in conjunction with the clinical presentation, facilitated an early identification and rapid evaluation of cardiogenic shock; furthermore, they led to the use of FoCUS, which can provide critical information quickly on site for a patient who is suddenly symptomatic after severe mechanical asphyxia in the pediatric emergency department, pediatric intensive care unit, or the prehospital setting.

Adrenomedullin as a potential biomarker involved in patients with hereditary hemorrhagic telangiectasia.

BACKGROUND: Adrenomedullin (AM) is a vasoactive peptide mostly secreted by endothelial cells with an important role in preserving endothelial integrity.  The relationship between AM and hereditary hemorrhagic telangiectasia (HHT) is unknown. We aimed to compare the serum levels and tissue expression of AM between HHT patients and controls. METHODS: Serum AM levels were measured by radioimmunoassay and compared between control and HHT groups. AM levels were also compared among HHT subgroups according to clinical characteristics. The single nucleotide polymorphism (SNP) rs4910118 was assessed by restriction analysis and sequencing. AM immunohistochemistry was performed on biopsies of cutaneous telangiectasia from eight HHT patients and on the healthy skin from five patients in the control group. RESULTS: Forty-five HHT patients and 50 healthy controls were included, mean age (SD) was 50.7 (14.9) years and 46.4 (9.9) years (p = 0.102), respectively. HHT patients were mostly female (60% vs 38%, p = 0.032). Median [Q1-Q3] serum AM levels were 68.3 [58.1-80.6] pg/mL in the HHT group and 47.7 [43.2-53.8] pg/mL in controls (p<0.001), with an optimal AM cut-off according to Youden's J statistic of 55.32 pg/mL (J:0.729). Serum AM levels were similar in the HHT subgroups. No patient with HHT had the SNP rs4910118. AM immunoreactivity was found with high intensity in the abnormal blood vessels of HHT biopsies. CONCLUSIONS: We detected higher AM serum levels and tissue expression in patients with HHT than in healthy controls. The role of AM in HHT, and whether AM may constitute a novel biomarker and therapeutic target, needs further investigation.

Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. / Neuritis óptica en pediatría: experiencia en 27 años y protocolo de actuación.

INTRODUCTION AND OBJECTIVE: In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS: We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS: Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS: ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.

Local negative permittivity and topological phase transition in polar skyrmions.

Topological solitons such as magnetic skyrmions have drawn attention as stable quasi-particle-like objects. The recent discovery of polar vortices and skyrmions in ferroelectric oxide superlattices has opened up new vistas to explore topology, emergent phenomena and approaches for manipulating such features with electric fields. Using macroscopic dielectric measurements, coupled with direct scanning convergent beam electron diffraction imaging on the atomic scale, theoretical phase-field simulations and second-principles calculations, we demonstrate that polar skyrmions in (PbTiO3)n/(SrTiO3)n superlattices are distinguished by a sheath of negative permittivity at the periphery of each skyrmion. This enhances the effective dielectric permittivity compared with the individual SrTiO3 and PbTiO3 layers. Moreover, the response of these topologically protected structures to electric field and temperature shows a reversible phase transition from the skyrmion state to a trivial uniform ferroelectric state, accompanied by large tunability of the dielectric permittivity. Pulsed switching measurements show a time-dependent evolution and recovery of the skyrmion state (and macroscopic dielectric response). The interrelationship between topological and dielectric properties presents an opportunity to simultaneously manipulate both by a single, and easily controlled, stimulus, the applied electric field.

Functional assessment of a series of paediatric patients receiving neurointensive treatment: New Functional status scale. / Valoración funcional tras tratamiento neurointensivo pediátrico. Nueva escala de estado funcional (FSS).

INTRODUCTION: Functional health, a reliable parameter of the impact of disease, should be used systematically to assess prognosis in paediatric intensive care units (PICU). Developing scales for the assessment of functional health is therefore essential. The Paediatric Overall and Cerebral Performance Category (POPC, PCPC) scales have traditionally been used in paediatric studies. The new Functional Status Scale (FSS) was designed to provide more objective results. This study aims to confirm the validity of the FSS compared to the classic POPC and PCPC scales, and to evaluate whether it may also be superior to the latter in assessing of neurological function. PATIENTS AND METHOD: We conducted a retrospective descriptive study of 266 children with neurological diseases admitted to intensive care between 2012 and 2014. Functional health at discharge and at one year after discharge was evaluated using the PCPC and POPC scales and the new FSS. RESULTS: Global FSS scores were found to be well correlated with all POPC scores (P<.001), except in category 5 (coma/vegetative state). Global FSS score dispersion increases with POPC category. The neurological versions of both scales show a similar correlation. DISCUSSION: Comparison with classic POPC and PCPC categories suggests that the new FSS scale is a useful method for evaluating functional health in our setting. The dispersion of FSS values underlines the poor accuracy of POPC-PCPC compared to the new FSS scale, which is more disaggregated and objective.

Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience. / Patología neurológica en una unidad de cuidados intensivos pediátricos de tercer nivel. Evolución funcional. Nuestra experiencia.

INTRODUCTION: Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. MATERIAL AND METHODS: Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. RESULTS: A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). CONCLUSIONS: Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care.

Observation of room-temperature polar skyrmions.

Complex topological configurations are fertile ground for exploring emergent phenomena and exotic phases in condensed-matter physics. For example, the recent discovery of polarization vortices and their associated complex-phase coexistence and response under applied electric fields in superlattices of (PbTiO3)n/(SrTiO3)n suggests the presence of a complex, multi-dimensional system capable of interesting physical responses, such as chirality, negative capacitance and large piezo-electric responses1-3. Here, by varying epitaxial constraints, we discover room-temperature polar-skyrmion bubbles in a lead titanate layer confined by strontium titanate layers, which are imaged by atomic-resolution scanning transmission electron microscopy. Phase-field modelling and second-principles calculations reveal that the polar-skyrmion bubbles have a skyrmion number of +1, and resonant soft-X-ray diffraction experiments show circular dichroism, confirming chirality. Such nanometre-scale polar-skyrmion bubbles are the electric analogues of magnetic skyrmions, and could contribute to the advancement of ferroelectrics towards functionalities incorporating emergent chirality and electrically controllable negative capacitance.

Acute cerebellitis in paediatric patients: Our experience. / Cerebelitis aguda en Pediatría: nuestra experiencia.

INTRODUCTION: Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS: We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS: Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS: Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.